Looking Beyond Health Care Reform

The question was a welcome one, given the heated, exhausting health care debate that has raged through the summer: On the day after health care reform (whatever form it takes), what are the potential stumbling blocks and opportunities?

That’s how moderator Michele Norris (of NPR’s All Things Considered) thoughtfully began the panel at the University of Chicago-curated “Chicago Contributes” health care forum, held Thursday in Washington, DC less than a day after President Barack Obama’s speech to Congress. Reform supporters might consider that question to be a jinx as Obama and the Democrats struggle to find a consensus plan, but it allowed the forum’s panelists to clear the political fog and put the focus back where it should be – on the challenging questions of access and cost reduction that face modern American medicine.

After a keynote address by Kathleen Sebelius, Obama’s Secretary of Health and Human Services, echoed many of the points the President made himself the night before, the stage was turned over to a national group of university experts that were grappling with these issues long before health care became the season’s political hot potato. The importance of access to health care, not just insurance, was summarized nicely (and immediately) by Gerard Clancy, Dean of the University of Oklahoma-Tulsa College of Medicine: “If we have 40-50 million people now with health care coverage, who’s going to take care of them?”

Three major topics arose again and again as the panelists discussed where improvements can be made in American health care and the best, most cost-efficient ways to create that change.

1) Bringing preventive medicine into the neighborhoods

In her remarks, Sebelius emphasized that 75% of health dollars are spent on chronic disease, and set goals of reducing diabetes, heart disease and obesity. This is in line with the commonly accepted view that the best way to cut health care costs and improve national health is through a greater emphasis on preventive medicine, a view that was echoed by basically every member of the panel. Both Clancy and Eric Whitaker, executive vice-president for strategic affiliations at the University of Chicago Medical Center, spoke about efforts to encourage more medical students to work in underserved communities. Pedro Jose Greer, the assistant dean of academic affairs at Florida International University School of Medicine, said that still more incentives were needed to draw young doctors into primary care medicine rather than higher-salaried specialties.

“Where we really need physicians is where we pay them the least,” Greer said. “[Primary care] is the most important aspect of medicine, bar none, period. And we’re not incentivizing our brightest students to go into it.”

But on the flip side, encouraging patients to go to neighborhood clinics rather than more expensive large hospitals is also a challenge. A University of Chicago student in the audience posed the scenario of his Brooklyn grandmother, who has multiple community health centers near her home but chooses to go to a hospital in Manhattan for her medical care. Whitaker said that attitude needs to change, citing data that quality metrics of some community health centers are better than large hospitals. “We build these temples of medicine, and there’s this culture we need to get around,” Whitaker said.

2) Improving public health with more than medicine.

Norris rightly asked whether other educational programs at universities should also take up a role in improving health care and public health. Clancy said the University of Oklahoma, in addition to rebranding their medical school the School of Community Medicine to reflect a broader emphasis, has also set up connections with the Schools of Education, Social Work and Public Health at the university to focus on community health. Whitaker pointed out that the University of Chicago Business School, School of Social Work and medical school all collaborate under the umbrella of the Urban Health Initiative. “They are bringing different perspectives and experiences to the table,” Whitaker said. One example: the funding of farmer’s markets on the South Side to improve access to healthy foods.

Another issue was convincing people who already have health insurance to care about public health, not just their own situation. As Whitaker put it, a lot of people mistakenly think “public health is about poor people.” But Patrick Soon-Shiong, executive director of the UCLA Wireless Health Institute, used recent medical news for the excellent argument that public health does in fact equal personal health.

“If you look at the SARS virus or H1N1, all of a sudden we re-recognize that the health of our fellow man or our community affects our own health,” Soon-Shiong said. “Your health is truly dependent on your community’s health. So we have a moral obligation for the health of the uninsured and the health of the poor, even from a selfish viewpoint.”

3) Technology can be used to cut costs, not increase them

Sebelius raised the example of Lakeside Hospital in Omaha, Nebraska, which became the first fully digitized hospital when it opened in August 2004. Sebelius said that the hospital’s use of fully-integrated electronic medical records and remote monitoring technology has allowed them to cover more patients, cut costs dramatically and even improve rates of costly and dangerous hospital-acquired infections. “They tell the story of what a reformed health system can look like,” Sebelius said.

During the panel, Soon-Shiong repeatedly came back to the promise of medical technology as a way of making health care both better and cheaper. Open availability of medical research can help both doctors and patients determine the best course of care for diseases such as pancreatic cancer, Soon-Shiong said, and the ability to transmit medical information can spread high-end expertise beyond the walls of the largest hospitals, allowing test results collected at community clinics to be analyzed remotely by specialists. But all of these advances must be implemented correctly, he cautioned, in order to reduce rather than increase costs. “If we don’t allow [electronic medical records] to talk to each other, we’ll have bridges to nowhere,” Soon-Shiong said.

The overall theme of the panel was one of a moral imperative to reform the health care system sooner rather than later, bringing the health care benefits afforded the wealthiest Americans to those less fortunate. All of the panelists hoped that the current energy around health care reform would not pass without at least some changes to the current system, afraid that settling for the status quo was the most dangerous possible outcome of the current political battle.

“I live in a country of great science,” Greer said. “But yet we’re aiming at a population that has a very high rate of uninsured and we’re not doing anything for that. If we make these discoveries, we’re obligated to make sure we take care of those individuals that are at risk.

We’ll post the archived video of this event when it’s available. To read our live-blog coverage of the event, click here.